Health systems are under pressure to provide ever-increasing interventions within limited budgets. New evidence on current treatments sometimes raises questions about their benefits in general, or for specific patient groups. However, attempts to stop or reduce the number of healthcare interventions to those who would benefit often fail. In April 2019, NHS England launched the Evidence-based Interventions (EBI) Programme. EBI identified 17 surgical procedures which they recommended stopping all together or limiting to patient groups thought most likely to benefit. The aim of the EBI programme was to reduce avoidable harm to patients, save professionals’ time, and maximise the value of care.
Within a wider research project the work described in this application for CPRD data specifically aims to examine the impact of the EBI programme on patient care provided by GPs and hospitals. Linked GP and hospital data allows us to examine more of the patient journey from first GP appointment with symptoms through referral to hospital-based care and onto surgery (if required). We will use these data to evaluate the care provided to patients with tonsillitis and a condition that affects the hand (known as Dupuytren’s contracture), who might receive two of the surgical procedures on the list of 17 identified by the EBI programme. We want to compare the number of GP visits and referrals to hospital care, delays to referral, and differences in drug and other treatments, before and after the start of the EBI programme.
BACKROUND: Health systems are under pressure to maintain services with limited resources. Research is identifying ‘unnecessary’ interventions where risks and costs are thought to outweigh benefits. NHS England launched the Evidence-based Interventions (EBI) Programme in 2019, identifying 17 surgical procedures for cessation or reduction. Restricting access to surgical procedures may have spillover effects within primary care. We will examine the patient pathway from first primary care consultation onwards to capture the effects of the EBI programme. Two case study conditions have been chosen for analyses that relate to two surgical interventions included in the EBI programme, Tonsillectomy and Dupuytren’s contracture release. This analysis is part of a wider mixed methods evaluation of the EBI programme (NIHR130547).
OBJECTIVES:
1. Examine changes in care pathways for patients who might be candidates for two EBI procedures (Tonsillectomy and Dupuytren’s contracture release) before and after implementation of the EBI programme.
2. Examine the resource use and cost of care before and after implementation of the EBI programme.
METHODS: Linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (Admitted Patient Care and Outpatient) data will be used to undertake a before and after study using four cohorts of patients; a pre and post EBI group for both conditions. We will run survival analyses to assess differences in the time to referral to specialist care and surgery in a before and after EBI cohort of patients. We will present means differences and 95% confidence intervals before and after EBI for other key outcomes such as consultations (GP and outpatient), tests, medications prescribed, and costs of care. These analyses will allow us to explore how increasing restrictions on access to NHS-funded surgery has affected the primary and secondary care pathways for patients with these two medical conditions.
Primary outcome
• Time to specialist referral for treatment of Dupuytrens contracture and tonsillitis for those who are referred.
Key Secondary outcomes
• Time to tonsillectomy or Dupuytrens contracture release surgery for those who receive it
Other outcomes
• Percentage of patients with related symptoms receiving tonsillectomy or Dupuytrens contracture release
• Percentage having surgical treatment versus non-surgical treatment as first treatment
• Number and type of primary care consultations
• Number and type of prescribed medications
• Number of radiological investigations and other diagnostic tests
• Number of referrals to other specialist care e.g., physiotherapy, mental health etc.
• Estimated cost of care.
Leila Rooshenas - Chief Investigator - University of Bristol
Joel Glynn - Corresponding Applicant - University of Bristol
Tim Jones - Collaborator - University of Bristol
William Hollingworth - Collaborator - University of Bristol
HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation